Celebration of Wellness, March 2019

Cervical Cancer Screenings and Well Women’s Examinations

By: Robert F. Lemert, MD, FACOG

Over the past few years, the recommendations for Cervical Cancer Screenings (Pap Smears) have changed. We now understand more about the virus that causes cervical cancer, and the technology to improve screenings has improved.  A Pap Smear is just part of a Well Woman’s Examination. A Well Woman’s Examination also usually covers the following topics: birth control counseling, vaccinations, health screenings, preconception care, and the latest information about your reproductive health.

 A cervical cancer screening is when your ob-gyn or other health care professional takes cells from the cervix and sends them to a lab for testing.  A Pap test looks for abnormal cells.  An HPV test looks for the human papillomavirus (HPV), which can be linked to cervical cancer. Due to improvements in the screenings for cervical cancer, the recommendations have changed for certain patient populations and age groups. If you are under the age of 21, you do not need a Pap test. If you are ages 21–29, you may have a Pap test every three years. If you are ages 30–65, you choose one of three options. You can have a Pap test and an HPV test (co-testing) every 5 years. You can have a Pap test alone every 3 years. You can have an HPV test alone every 5 years. If you are 65 years or older, you do not need screening as long as you have no history of cervical changes or have had three negative Pap test results in a row or two negative co-test results in a row within the past 10 years. The most recent test needs to have been performed within the past 5 years.

It is important to remember that even if you have been vaccinated against HPV, you still need to have screenings. Women also need to have screenings after a hysterectomy if they still have a cervix. Exceptions to the above recommendations include: 

• You have human immunodeficiency virus (HIV)
• You have a weakened immune system
• You have a history of cervical cancer
• You were exposed to diethylstilbestrol before birth

You may need more frequent screenings if any of the above applies to you. If you have had a hysterectomy in which your cervix was removed and you have a history of cervical cancer or moderate to severe cervical changes, you should continue to have screenings for 20 years after your surgery. If you have had a hysterectomy in which your cervix was removed and you have no history of cervical cancer or cervical changes, you do not need screening.

 These recommendations are for the Pap Screening test. Your Well Women’s visit is important for several other reasons. You can learn about choosing the right birth control method for you. Some examples include the birth control pill, an intrauterine device (IUD), the patch, condoms, or an implant. You can learn more about breast cancer, colon cancer, and other types of cancer. You can get vaccinations against the flu, human papillomavirus (HPV), and more.  You can be screened for high blood pressure, diabetes, bone density for osteoporosis, and more. You can also talk about your mental health at these visits. Depression is a common but serious illness. Depression can be mild, moderate, or severe. To diagnose depression, your obstetrician–gynecologist or other health care provider will discuss your symptoms, how often they occur, and how severe they are. You can also be screened for sexually transmitted infections (STIs) such as chlamydia, gonorrhea, and genital herpes. You can discuss what happens during intercourse, pain during sex, hormonal changes related to sex, or different forms of sex. You can learn about body mass index (BMI), exercise, obesity, diet, surgery, and health problems associated with being overweight. You can discuss premenstrual syndrome (PMS), painful periods, your first period, heavy bleeding, or irregular periods. If you are planning to become pregnant, it is a good idea to have preconception counseling. Your obstetrician–gynecologist or health care provider will ask about your diet and lifestyle, your medical and family history, medications you take, and any past pregnancies. Your Well Women’s examination is also a good time to begin getting help with menopause symptoms, urinary incontinence, getting pregnant, or relationship problems.